Groin Prep for Cardiac Cath

xrayrn · Mar 22, 2006

Yes, it should always be done beforehand--It saves us time in the actual Interventional and Cath Labs. Problem is, it rarely does get done, if ever. If you have time, why not? Order the xray, labs, etc, do what you can and get on with it....

neneRN, BSN, RN · Mar 22, 2006

Nope, don't routinely do it; the other things we need to get done are the priority. More than often the acutes are EMS pts who also need triaged in addition to all the meds/interventions. Every minute counts, and I'm not wasting the 15-20 minutes I have with the pt to shave them, esp since when we take the pts up to the lab, its not like everyone's gloved up and ready to go; they have at minimum an RN, an RT, and a cardiac tech. When they get the pt, all that needs done in the first 2-3 minutes is to be hooked up to the monitor- between the three of them, I'm sure someone can wield a razor. Especially since I have done the EKG/put in 2 IVs/sent labs/got a CXR/given the ASA,Plavix, NTG gtt, Heparin, Morphine, Lopressore/obtained signed consents BY MYSELF IN THE LAST 15 MINUTES. Heaven forbid that we not attach some extension tubing to the lines too, they also freak out if that's not done.

I do prep the groin when we send a pt to the lab if its not an acute situation, i.e., those that have a good story/borderline EKG/second positive troponin who end up going an hour or two after they get to the ER.

This turned into little mini rant- sorry! Relations between cath lab and ER nurses at my facility is an ongoing thing. (I also love when they call me three times over the course of 2 min to see if I've left the ER yet; um, I could be even closer by now if you'd quit calling)

tridil2000, MSN, RN · Mar 22, 2006

ALL: Docs want us the ED to prep the groin on patients going to Cath Lab for emerging MIs, along with the lopressor, heparin, ntg drip, pcxr, lab and two IVs. Goal is 15 minutes. In addition the Docs think us doing the groin prep will save time too. Our goal is get the patient Door to Cath within 60minutes. Any of you all doing this (the groin prep) out there?
Thanks

personally, i think it is unreasonable to ask the er staff to do that. from the moment the ecg is done and the >st waves are seen, there is tons to do on an infacting mi to DECREASE o2 demand on that infarcting heart! many times these pts need multiple labs drawn and properly labled, including t&s, as well as 2 large bore ivs. top off mixing and calculating meds, monitoring the effects of those meds, preparing the paperwork, making sure labs haven't hemolyzed, and the xrays are ready, in addition to taking one freaking minute to reassure the pt that he or she is in great hands and will be alright, (oh and the ua would be nice to get too) the 1 hour window closes fast! there's no reason imo, while the consent is being addressed in the preop area, and iv sedation is getting administered, that the groin could not be sterile-prepped then.

our job in the ed is to get them TO the cath lab safely. you can't be worried about a prepped groin if the labs get all screwed up and the pt gets tachy out of sheer panic!

first things first. we are a team. we each do our part, do it well, and do it right the first time then pass the ball to the next player. :idea:

Q: would you want your groin prepped in the ed or YOUR cbc and t&s on the chart (not someone else's), your bp stable and your ivs working on the way to the cath lab? :uhoh3:

xrayrn · Mar 22, 2006

Ok, sorry that is just ridiculous--First of all it does'nt take 15 to 20 minutes to shave a person's groin (maybe you don't know how--someone could show you--and I am not trying to be funny here), but it does save time in a life-threatening situation--which is what is usually the case when a patient is going from the ER to the lab---Come on, can't we just work together without all the complaints and irrational ones at that--It doesn't take a RANT about all the things you have to do to get your point across, especially if your argument is unconvincing and just plain well, silly, to be honest AND you imply that WE don't also have a lot to do and can't, as you put it, "wield" a razor--PS...The RT IS usually the cath lab tech and there is a whole lot going on. ...sigh...Just do your job and get over yourself--Really? Complaining over helping out with a two minute shave (possibly less)...Whatever happened to teamwork...:) Working in the ER I would imagine you get asked to do a lot more difficult things than this and guess what, you do it don't you? You do if you still work there I bet.

Oh, and the reason you probably get all those calls is because the DOCTOR is also breathing down our necks so check the attitude--It isn't with the right person obviously...Sorry, I guess THIS was a little "rant" of my own, maybe because I would and have done it and don't see your problem over such a small thing..

xrayrn · Mar 22, 2006

Ok-Let me clarify what they mean by "prep" the groin. It means take a razor and shave (a circle of area) where the superficial femoral artery and veins are--Not sterile anything--that is not something that would even make sense. Maybe that is the problem, that you didn't know that? Yep, that's all you gotta do..Pretty easy right?

neneRN, BSN, RN · Mar 22, 2006

Okay, first off, let me say that I know I don't know everything that goes on in the cath lab; I just do ER. I'm not trying to come off as the "ER supernurse.

When I said that "I'm not wasting the 15-20 minutes I have with the pt...", what I meant is that I have 15-20 minutes to do all of the other things that I listed. I would think any nurse would agree that doing all of above mentioned in that amount of time comes down to split second timing. I'm well aware that shaving the pt takes about a minute.

You're talking about TEAMWORK, so why does your argument seem to be that the groin HAS to be prepped by ER staff? If you're hearing the ER nurses pretty much agree that its not a priority for us, then as you said "just do your job and get over it". If we're all such a team, then it is equally your responsibility.

Yes, working in the ER, I do deal with much more "difficult" things; I guess part of the reason I don't have time for a groin prep is because in addition to my acute MI, I still have other pts with "difficult" things- I don't have the luxury of just having one pt at a time.

I get that there is "a whole lot going on" in the cath lab, but as I said before, in THE FIRST 2-3 minutes that a pt is there, its pretty much just hooking the pt up to the monitors. I happen to be there the first 2-3 minutes as I give report to the RN while the RT and tech (yes they are 2 different people at my facility) are standing there.

Amazing how that doctor can be breathing down your neck from where he's often standing at bedside in the ER. Our cardiologists come right down to see acutes unless they're already doing a cath.

But I'm sure all these arguments are also "silly"

tridil2000, MSN, RN · Mar 22, 2006

Ok, sorry that is just ridiculous--First of all it does'nt take 15 to 20 minutes to shave a person's groin (maybe you don't know how--someone could show you--and I am not trying to be funny here), but it does save time in a life-threatening situation--which is what is usually the case when a patient is going from the ER to the lab---Come on, can't we just work together without all the complaints and irrational ones at that--It doesn't take a RANT about all the things you have to do to get your point across, especially if your argument is unconvincing and just plain well, silly, to be honest AND you imply that WE don't also have a lot to do and can't, as you put it, "wield" a razor--PS...The RT IS usually the cath lab tech and there is a whole lot going on. ...sigh...Just do your job and get over yourself--Really? Complaining over helping out with a two minute shave (possibly less)...Whatever happened to teamwork...:) Working in the ER I would imagine you get asked to do a lot more difficult things than this and guess what, you do it don't you? You do if you still work there I bet.
Oh, and the reason you probably get all those calls is because the DOCTOR is also breathing down our necks so check the attitude--It isn't with the right person obviously...Sorry, I guess THIS was a little "rant" of my own, maybe because I would and have done it and don't see your problem over such a small thing..

from your post, i really do not think you understand what needs to happen in those 59 minutes to get the pt to you stable and ready for the procedure. there are a ton of more difficult things things to do in the er (and any area) other than shaving a groin. difficulty is NOT the arguement. it is the resource of one rn and prioritizing what MUST be done to make sure the pt gets through those next 59 minutes, which FLY. to say just take a minute and DO it is also pointless and something nurses have said to one another for years. you and the cardiologist can have all the temper tantrums you want if the groin isn't shaved, and i will firmly state to look at the chronilogical order of treatments given in the chart. if any of you would rather these other things NOT get done properly, in order for the groin to be shaved, then please tell me what to let slide in order to accomplish the shaving.

i welcome you to follow an er rn for those 59 minutes and come back and tell me when you shaved the groin.

asking the ed to shave the head for surgery from a trauma is also placing priorities out of order. it's just not in the top 10 things to get done in an acceptable time frame in the emergency dept.

nursejennie76 · Mar 22, 2006

We prep the groin when we have a patient going to the cath lab, we have a check off list and this is a task that only takes a minute or two at the most. We are a chest pain center and also have a door to cath lab goal of 60 minutes. I have never heard anyone have a problem with the groin prep, we shave and cleanse with betadine, and it is a quik process. Anything to help the cath lab get into that patients clogged vessel and open up to save some heart muscle during an acute MI is worth it in my book.

rjflyn, ASN, RN · Mar 22, 2006

For what it's worth I have yet to work in an ER where I am taking care of a person that is actually having an acute MI alone. If the cath team asked i'm sure that someone could get to it if given enough time. I do know the last couple of patients I sent there would not have been. It also depends on the kind of prep wanted- ie just the area or the old navel to knees to bed prep- there are still places that do it.

We also have a couple doc's who are doing bedside echocardiograms.

rj

Altra, BSN, RN · Mar 23, 2006

Our door to lab time frame is *30 minutes* -- no, we do not shave.

The list of things that get done in that 30 minutes has already been discussed - I won't repeat it. And yes, the nurse with the cath lab pt. also has 2-4 other patients at the same time.

andhow5, BSN, RN · Mar 25, 2006

The door to lab time frame at my facility is 30 minutes. I took a cath patient down just this week.

I've helped other nurses with their cath patients. And the time really does go by quickly. And I'll always accompany the nurse I'm helping . A soon as we get to the door of the lab and I can see the lab team, I return to my patients and watch the other nurse's patients until she returns and can finish charting.

On my patient this week, I did everything myself except my 2nd large bore IV. When my Charge Nurse found out my patient was getting ready to roll, he ran in and popped the 2nd line in for me, thank goodness! And the wonderful cath lab nurse came to the ER to accompany me to the lab - I could've just kissed him, bless his heart! Our ER to door time was 23 minutes (even with it being the middle of the night and the lab team being called in).

And I still had 5 other patients with an empty trauma room (with an inbound trauma not too far out). So needless to say, I felt a tad bit puckered!

However, we've never been approached about groin prep... I was a little surprised that you all have had that experience. Because at the facility I had come from, that cath lab never asked ER to groin prep either.

Maybe it's a regional thing? Personal preference of the Cardiologist? The particular lab team? I don't know - I've never observed a cath being done, so I have absolutely NO clue as to what the cath team RN does.

If I was asked, and I had time (and someone from cath lab had in-serviced me on how they wanted it done, very specifically) I would be happy to do it. If I was rushed, I'm sorry - I wouldn't.

I'm a firm believer in starting whatever I can get started on my patient before releasing them into another nurse's care (after all priorities are taken care of). After all, as a previous poster stated, it's all about teamwork.